Kenpo Karate of Woodland Park, Colorado
Welcome to our Studio
Introductory Application for Kenpo
Name _________________ Date ____________ Email _______________
_____Male _______Female Age ______ Date of Birth _______________
(Parent or Legal Guardian if under 18) Name _______________________________
Home Phone Number ___________ Emergency Contact Number _________________
Is anyone else responsible for the decisions or the tuition for the lessons? ____YES ____ NO
If YES, Who : ________________________________
How did you find out about Kenpo Karate of Woodland Park, Colorado ______________
Learning Objectives __Self Defense __Confidence __Strength Building __ Weight Control __Sport ___Physical Conditioning ___Martial Arts Philosophy ___Meditation/Relaxation ___Discipline ___Tournaments/Competitions ___Stress Relief ___Bully Management
Waiver and Release
I hereby agree to participate in Kenpo Karate of Woodland Park, Colorado (the school) martial arts & fitness programs given by its owners, employees and agents, upon the understanding that:
1. I represent to PHOENIX fitness & Kenpo Studio of Colorado Springs that I have no physical, mental or emotional illness that could impair training or that could make the training injurious. While every effort will be made on the part of the school to make the classes and facility as safe as possible, I realize that any physical activity has the potential for injury and I waive any claim of accidental and/or negligent tort against the school and its owner(s), employees and agents resulting from this activity.
2. I also release the school from any liability arising from my use of any and all equipment provided by the school.
3. I understand that I will also be held responsible for any negligent damage (replacement/repair) to equipment I am using that is owned or provided by the school.
__________________ ______________________ __________________
Student Parent or Legal Guardian(if under 18) Witness